Young Scholar Program Application

This is an application for admission to the Young Scholar Program at Cal Poly Pomona beginning:

Have you previously taken classes at Cal Poly Pomona?

Yes

No

Bronco ID

Last Term attended

Expected High School Graduation

First Name

Last Name

Preferred First Name

Other Name(s) that may appear on your academic records

First

Last

Mailing Address

Country

Street

City

Region

Postal Code

Is your Current Mailing Address same as your Home Address?

Yes

No

Home Address

Country

Street

City

Region

Postal Code

Cell Phone Number

Permission to text?

Email Address

Birthdate

Gender

Male

Female

Non-Binary

Decline to State

Academic GPA (Weighted)

Current Grade Level

Junior

Senior

Other

You MUST be a Junior or Senior to Apply. Please contact your HS Guidance Counselor to establish a plan for application.

Select your school

Do you claim California residency?

Yes

No

You MUST be a California Resident to Apply. Please contact your HS Guidance Counselor to establish a plan for application.

Certification

CERTIFICATION - TO BE READ AND SIGNED BY ALL APPLICANTS TO CERTIFY THAT ACCURACY OF THE INFORMATION PROVIDED.

The California State University expects you to provide complete and accurate responses to the items on this application for admission. The official documents you submit in support of this application much be authentic and unaltered records that pertain to you. By providing your signature you are certifying the accuracy and completeness of the information above.

I certify that under penalty of perjury, or after being duly sworn, that I have provided complete and accurate responses to the items on this application. I further certify (swear) all official documents submitted in support of this application are authentic and unaltered records that pertain to me. I authorize release of any information submitted by me in connection with this application to any person, firm, corporation, association or government agency, but only to verify or explain the information, obtain pertinent records or in connection with perjury proceedings. I understand that any misrepresentation may be cause for denial or cancellation of admission or enrollment.

I certify (swear) that so long as I am a student at this institution, I will advise the residence clerk if there is a change in any of the facts affecting my residence.

Academic Plan (Hidden)

Young Scholar Program Application

Please contact the responsible party on your High School Campus for any questions.

Certification